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Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population

Lin, Yi Ting ; Lampa, Erik ; Fall, Tove LU ; Engström, Gunnar LU and Sundström, Johan (2021) In Blood Pressure 30(4). p.237-249
Abstract

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical use, but more knowledge about the prevalence and variability in ABPM-derived phenotypes in the general population is needed. We describe these parameters in the community-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. Methods: We examined 5881 men and women aged 50–64 with 24-hour ABPM recordings using validated monitors. ABPM phenotypes were defined according to European guidelines. White coat hypertension was defined as elevated office BP (≥140/90 mmHg) with normal mean ambulatory BP (<135/85 mmHg in day-time, <120/70 mmHg in night-time, <130/80 mmHg over 24-h); and masked hypertension as normal office BP... (More)

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical use, but more knowledge about the prevalence and variability in ABPM-derived phenotypes in the general population is needed. We describe these parameters in the community-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. Methods: We examined 5881 men and women aged 50–64 with 24-hour ABPM recordings using validated monitors. ABPM phenotypes were defined according to European guidelines. White coat hypertension was defined as elevated office BP (≥140/90 mmHg) with normal mean ambulatory BP (<135/85 mmHg in day-time, <120/70 mmHg in night-time, <130/80 mmHg over 24-h); and masked hypertension as normal office BP (<140/90 mmHg) with elevated mean ambulatory BP (≥135/85 mmHg in day-time, ≥120/70 mmHg in night-time, ≥130/80 mmHg over 24-h). Blood pressure variability was assessed using the coefficient of variation (CV), standard deviation (SD), and average real variability. Results: Based on the ABPM recordings, 36.9% of participants had 24-h hypertension, 40.7% had day-time hypertension, and 37.6% nocturnal hypertension. Among participants treated with anti-hypertensive drugs, one in three had elevated office blood pressures, and more than half had elevated 24-h, day-time or nocturnal blood pressures. Among participants without anti-hypertensive drugs, only one in six had elevated office blood pressures, but one in three had elevated 24-h, day-time or nocturnal blood pressures. Men had higher 24-h blood pressures, more masked hypertension, but less white-coat hypertension than women. The prevalence of white-coat hypertension increased with age, but not the prevalence of masked hypertension. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. The variance in ABPM on repeated measurements was substantial. Conclusions: In the middle-aged general population, masked hypertension is an underappreciated problem on the population level.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ambulatory blood pressure monitoring, hypertension, Swedish CArdioPulmonary bioImage Study, variability
in
Blood Pressure
volume
30
issue
4
pages
237 - 249
publisher
Taylor & Francis
external identifiers
  • scopus:85103681306
  • pmid:33797315
ISSN
0803-7051
DOI
10.1080/08037051.2021.1903302
language
English
LU publication?
yes
id
9a5d90fd-d66a-49a2-ab26-2aac9b528027
date added to LUP
2021-04-13 14:37:55
date last changed
2025-10-20 16:03:34
@article{9a5d90fd-d66a-49a2-ab26-2aac9b528027,
  abstract     = {{<p>Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical use, but more knowledge about the prevalence and variability in ABPM-derived phenotypes in the general population is needed. We describe these parameters in the community-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. Methods: We examined 5881 men and women aged 50–64 with 24-hour ABPM recordings using validated monitors. ABPM phenotypes were defined according to European guidelines. White coat hypertension was defined as elevated office BP (≥140/90 mmHg) with normal mean ambulatory BP (&lt;135/85 mmHg in day-time, &lt;120/70 mmHg in night-time, &lt;130/80 mmHg over 24-h); and masked hypertension as normal office BP (&lt;140/90 mmHg) with elevated mean ambulatory BP (≥135/85 mmHg in day-time, ≥120/70 mmHg in night-time, ≥130/80 mmHg over 24-h). Blood pressure variability was assessed using the coefficient of variation (CV), standard deviation (SD), and average real variability. Results: Based on the ABPM recordings, 36.9% of participants had 24-h hypertension, 40.7% had day-time hypertension, and 37.6% nocturnal hypertension. Among participants treated with anti-hypertensive drugs, one in three had elevated office blood pressures, and more than half had elevated 24-h, day-time or nocturnal blood pressures. Among participants without anti-hypertensive drugs, only one in six had elevated office blood pressures, but one in three had elevated 24-h, day-time or nocturnal blood pressures. Men had higher 24-h blood pressures, more masked hypertension, but less white-coat hypertension than women. The prevalence of white-coat hypertension increased with age, but not the prevalence of masked hypertension. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. The variance in ABPM on repeated measurements was substantial. Conclusions: In the middle-aged general population, masked hypertension is an underappreciated problem on the population level.</p>}},
  author       = {{Lin, Yi Ting and Lampa, Erik and Fall, Tove and Engström, Gunnar and Sundström, Johan}},
  issn         = {{0803-7051}},
  keywords     = {{Ambulatory blood pressure monitoring; hypertension; Swedish CArdioPulmonary bioImage Study; variability}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{237--249}},
  publisher    = {{Taylor & Francis}},
  series       = {{Blood Pressure}},
  title        = {{Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population}},
  url          = {{http://dx.doi.org/10.1080/08037051.2021.1903302}},
  doi          = {{10.1080/08037051.2021.1903302}},
  volume       = {{30}},
  year         = {{2021}},
}